Combined Treatment for Band Keratopathy

I read with interest the two case reports by Kwon et al. on ‘‘New Treatment for Band Keratopathy: Superficial lamellar Keratectomy, EDTA Chelation and Amniotic Membrane Transplantation’’ (1). In their article, they describe two cases of calcific band keratopathy (CBK) that were treated with a combination of EDTA chelation, superficial keratectomy and amniotic membrane transplantation. The authors concluded that this combined treatment was a safe and effective method for the removal of deep situated calcium plaques, thus allowing the recovery of a stable ocular surface. With my colleagues, I have recently published a study that looked at the effectiveness of EDTA chelation in CBK (2). In the 65 eyes of 54 patients that we have followed after EDTA chelation, we found significant visual improvement of two or more lines in up to half of the eyes that were treated, as well as symptomatic relief in 98% of the patients. Some of our cases with deep and dense CBK required from 5 to 45 min of EDTA application for complete resolution. This might explain the unsatisfactory results with EDTA chelation alone in the two cases reported by Kwon et al. who applied the EDTA for just 2.5 min in both cases. The authors reported no recurrence of symptoms in their patients during their mean follow-up period of 13.5 months. In our study, we found that the mean time for recurrence was 17.7 yr. The absence of any recurrences in the cases described by Kwon et al. could be attributed to their shorter follow-up period rather than to the success of the combined treatment modality they describe. In short, I believe that EDTA chelation, when used properly, is an effective treatment for CBK. It is simple, inexpensive and avoids the additional risks of an invasive procedure such as superficial keratectomy, or the added costs of amniotic membrane transplantation, especially in eyes with poor visual potential. We recommend it as a first line treatment for calcific band keratopathy.